Rheumatoid Arthritis and Chikungunya Similarities and Differences

Linda Crampton is a writer and teacher with a first class honors degree in biology. She often writes about the scientific basis of disease.

Aedes aegypti is a mosquito which transmits the viruses that cause yellow fever, dengue, and chikungunya. It's often known as the yellow fever mosquito. | Source

An Autoimmune Disease and an Infection

Rheumatoid arthritis is an autoimmune condition in which the body's immune system mistakenly attacks joints in the body. Chikungunya is an infectious disease caused by a virus entering the body through a mosquito bite. At first glance, the two disorders seem completely different. Some of their symptoms are so similar that it may be hard for a doctor to make a correct diagnosis without a very specific type of blood test, however.

Chikungunya infections are present in Asia, Europe, and Africa and on islands in the Indian and Pacific Oceans. Recently, they have also appeared in North, Central, and South America and in the Caribbean. Some health experts suspect that chikungunya will become more common in North America. Distinguishing a chikungunya infection from rheumatoid arthritis is therefore very important.

A reconstruction of the Chikungunya virus as viewed through an electron microscope | Source

According to WHO (the World Health Organization), the name "chikungunya" is derived from a word in the Kimakonde language of the Makonde people in Tanzania. The name means "to become contorted". This phrase refers to the stooped posture that some people assume due to the severe joint pain produced by the viral infection.

The Cause of Chikungunya

The chikungunya virus is transmitted through a bite by two species of mosquitoes—Aedes albopictus and Aedesaegypti. These are normally inhabitants of tropical and subtropical areas, but both have been introduced to the United States.

At the moment, most North Americans that have chikungunya have just returned from a trip to a tropical country inhabited by the mosquitoes. Unfortunately, the insects are spreading to new areas. This is especially true for Aedes albopictus, which can survive in temperate climates as well as tropical ones. A few people have developed chikungunya after a mosquito bite in the US as opposed to a bite in another country.

When a female mosquito bites someone to suck up blood, she injects an anticoagulant to stop her victim's blood from clotting. (Only female mosquitoes bite.) The virus enters the victim's blood in the mosquito's saliva. Later, when an uninfected mosquito bites the victim to withdraw blood, she may also withdraw the virus. If the virus survives in the new mosquito, the insect is then capable of infecting someone else. Chikungunya symptoms may develop in as little as two to as long as twelve days after a mosquito bite.

Aedes albopictus also transmits the chikungunya virus and is capable of surviving outside tropical regions. This female is feeding on blood. The insect is often known as the Asian tiger mosquito. | Source

Possible Symptoms and Treatment

Some people never develop symptoms from a chikungunya virus infection, but most do. The most common effects are fever and severe joint pain, which is often disabling. Other possible symptoms include swollen joints, muscle pain, a rash, a headache, and nausea.

At the present time, there is no medication available to treat chikungunya. Antibiotics aren't helpful because they don't destroy viruses. The body is nearly always able to defeat the chikungunya virus by itself, however, and fatalities are rare. They are most common in elderly people.

Even though chikungunya is rarely dangerous, it's very unpleasant and often painful. It can also produce lingering effects that may last for a long time. One of the symptoms which may linger—even for years—is the joint pain.

Anyone with unexplained symptoms should visit a doctor. In the case of chikungunya, the doctor may prescribe pain killers, rest, and fluids. He or she may also offer other suggestions to help the patient.

A rash caused by the chikungunya virus | Source

Incidence of Locally Transmitted Disease

According to the CDC (Centers for Disease Control and Prevention), from 2006 to 2013 all cases of chikungunya in the United States appeared in people who had travelled to other countries and become infected there. This conclusion was based on the illnesses that were diagnosed and reported.

In 2014, twelve cases of chikungunya acquired from a mosquito bite within the United States were reported. They all occurred in Florida. (As in the following years, a higher number of cases was reported in travellers to other countries.)

In 2015, another case arising within the United States was reported. This infection occurred in Texas.

In 2016, no cases of locally transmitted chikungunya in the United States were reported.

It should be noted that in 2014 to 2016 amost all of the cases in Puerto Rico were locally transmitted.

While the number of cases caused by mosquitoes within the United States may not sound significant, it shows that at least some of the mosquitoes in the country are (or were) capable of carrying the chikungunya virus. The situation needs to be watched carefully.

What Is Chikungunya?

Currently, researchers say that the chikungunya virus isn't transmitted from person to person. There may be one exception, however. According to the CDC, "Chikungunya virus is transmitted rarely from mother to newborn around the time of birth."

Preventing Mosquito-Borne Diseases

The best way to prevent chikungunya or other mosquito-borne diseases is to use insect control and avoidance techniques. Standing bodies of water where mosquito larvae grow should be drained. Even a small puddle is an attractive place for a female to lay eggs. Protective clothing should be worn in areas frequented by mosquitoes. Insect repellents are also helpful. Doors and windows should have screens. Mosquito nets over beds are useful in areas where lots of the insects are found.

A synovial joint | Source

How Does Rheumatoid Arthritis Develop?

In rheumatoid arthritis, or RA, the immune system attacks a thin membrane called the synovium. The synovium is also known as the synovial membrane. This membrane lines the capsule around many of our joints, which are known as synovial joints.

The immune system's attack involves inflammation. The inflammation causes the synovium to thicken. Eventually the inflammation from the synovium spreads to the cartilage and bone in the joint and causes these structures to break down. The damage may stop the ligaments, tendons, and muscles around the joint from doing their jobs and may eventually lead to deformity in the affected area.

The trigger for the immune system's attack is unknown. There seems to be a genetic component to the disorder. The possession of a certain gene or genes is thought to make a person more susceptible to an environmental trigger that leads to joint damage. The trigger might be a viral or bacterial infection or a hormonal change. Neither of these theories have been proven, though.

A Rheumatologist Discusses Rheumatoid Arthritis

Possible Symptoms of the Disease

Someone with rheumatoid arthritis will probably find that their joints feel warm, tender, and swollen. The joints may also look red. The person may experience stiffness, especially after getting out of bed in the morning. They may experience fatigue, low energy, and an occasional fever as well.

The joints in the hands and wrists are most commonly affected, usually on both sides of the body. Other joints may also be affected by the disorder, however.

RA may involve symptoms in other parts of the body in addition to joints. A decrease in red blood cells, or anemia, is a possible symptom. The patient may also experience a dry mouth and dry eyes. Rarely, the blood vessels or the membrane around the lungs or heart may become inflamed.

There is considerable variability in the seriousness of rheumatoid arthritis. Some people experience flare-ups (periods when their symptoms are worse) alternating with remissions (periods when their symptoms are much weaker or absent). For other people, the symptoms are constant. The symptoms remain mild for some people, but for many people they are progressive. New medications can weaken this progression, however.

Living With Rheumatoid Arthritis

Possible Treatments for the Disease

Anyone with rheumatoid arthritis or joint pain must be under the care of their doctor, who will prescribe treatment. There are many potentially effective treatments available. Some are more effective for certain patients than others, however.

A relatively new treatment that is often very effective is the use of DMARDS (disease-modifying antirheumatic drugs). These are medications that suppress the patient's overactive immune system, interfering with the inflammation that is damaging the joints. Methotrexate is a commonly prescribed DMARD, but there are others.

One important group of DMARDs is the biologics, which are mentioned in both of the arthritis videos above. Biologics are medications produced by genetic engineering. They are proving to be very useful for some cases of rheumatoid arthritis.

Diagnosing the Disease

One reason that RA may be misdiagnosed—at least in the early stage—is that there is no test that proves that someone has rheumatoid arthritis. Inflammation and painful joints can be part of other diseases. Joint X-rays may look normal or only slightly abnormal in the early stage of RA.

There are blood tests which can strongly suggest that someone has rheumatoid arthritis, but they aren't conclusive. Many people with RA tend to have distinctive factors in their blood. Not everyone with RA has these factors in their blood, however, and some people have the factors without having RA.

Generally, a doctor makes a diagnosis of rheumatoid arthritis based on a combination of a patient's symptoms, an examination, and multiple lab tests.

Deformity resulting from advanced rheumatoid arthritis | Source

A Comparison of Rheumatoid Arthritis and Chikungunya

The symptoms of rheumatoid arthritis follow a different pattern of development from those of chikungunya. Chikungunya begins with a fever while rheumatoid arthritis generally doesn't, for example. Symptoms of joint pain caused by the chikungunya virus generally appear suddenly and are severe, while those of rheumatoid arthritis appear more slowly and gradually worsen. After the initial symptoms of chikungunya have subsided and only joint pain remains, however, it can be difficult to tell the two diseases apart.

A blood test is often unhelpful in distinguishing the two diseases. Both disorders involve an elevated blood level of a specific type of T-cell, for example. In order to positively identify chikungunya, a blood test has to show antibodies to the virus in the patient's blood. Unfortunately, at the moment this type of blood test is only available at the CDC and at specific research laboratories.

Why Does it Matter if the Two Diseases Are Confused?

Early and effective treatment of rheumatoid arthritis is very important because it can delay and reduce joint damage. If someone with rheumatoid arthritis believes that their joint pain is a result of a chikungunya infection, they may take pain killers to feel more comfortable but take no medications to help protect their joints. Joint damage could therefore continue unabated.

On the other hand, if someone with a chikungunya infection is diagnosed with rheumatoid arthritis, they may be prescribed immune system suppression drugs that they don't need. All drugs have side effects. While these side effects may be a small price to pay for someone who is trying to prevent permanent joint damage, relieve pain, and and lead a relatively normal life, they may be unpleasant and unnecessarily harmful for someone with chikungunya. Suppressing the immune system may also make the patient more susceptible to infections.

Hopefully we will move forward in our understanding of rheumatoid arthritis and chikungunya in the near future. | Source

Rheumatoid Arthritis and Chikungunya in the Future

I hope that the blood test that distinguishes chikungunya from rheumatoid arthritis becomes more widespread. I suspect that it will if chikungunya becomes more common in North America. It would also be wonderful if an antiviral drug or a vaccine is developed for the infection.

Studying the way in which the chikungunya virus causes joint pain may help researchers learn more about the pain caused by rheumatoid arthritis. RA can be a major health problem, yet it's still not completely understood. Although there's no evidence that the chikungunya virus causes the same effects inside joints as rheumatoid arthritis, there may be some similarities. Studying the viral infection may be important not only to help people who are infected by the virus but also to help people with other diseases that affect joints, including rheumatoid arthritis.

References

The CDC (Centers for Disease Control and Prevention) maintains a webpage containing current news about the spread of chikungunya in the United States.

The NIH (National Institutes of Health) maintains a webpage with detailed information about rheumatoid arthritis.

This report from the Washington University School of Medicine in St. Louis discusses the shared symptoms of chikungunya and rheumatoid arthritis.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Questions & Answers

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AUTHOR

Linda Crampton

3 years agofrom British Columbia, Canada

Thank you for the comment, RTalloni. The study of human health can certainly be difficult. There are so many factors to consider!

RTalloni

3 years agofrom the short journey

This is an interesting and important read. What science has yet to learn about diseases, testing, and treatments sometimes makes me very suspicious of the declarations made about some of the difficult health needs people face. Thanks for a look at chikungunya and what we need to know about it.

AUTHOR

Linda Crampton

4 years agofrom British Columbia, Canada

Thanks for the comment, Deb. The ways in which climate affects disease are interesting.

Deb Hirt

4 years agofrom Stillwater, OK

Northern climates definitely have their benefits, and I never realized that until now. I am just flabbergasted with some of the diseases out there that have only the climate between health and illness.

AUTHOR

Linda Crampton

4 years agofrom British Columbia, Canada

I hope you get an accurate diagnosis very soon, Carolyn, and that you're given some effective help. Best wishes for the future. Thank you for the comment.

Carolyn Emerick

4 years ago

Thank you for this! I was diagnosed with early onset RA last year, but didn't like the dr so I switched, then the new one keeps flip flopping on my diagnosis. I will have to do some more research, but this is excellent!

AUTHOR

Linda Crampton

4 years agofrom British Columbia, Canada

Hi, Mel. Thanks for the comment. I'm sorry that you have to deal with psoriatic arthritis, but I'm glad that you finally got the correct diagnosis. I think people are going to hear a lot more about chikungunya in the future!

Mel Carriere

4 years agofrom San Diego California

There are actually more cases of Chikungunya than Ebola, but I have not heard any public outcry. This topic interested me because I have psoriatic arthritis, which is a type of rheumatoid arthritis. It never showed up on blood tests, which could be why it took a while before a skilled rheumologist found it. Great hub!

AUTHOR

Linda Crampton

4 years agofrom British Columbia, Canada

Hi, Bill. I hope you enjoyed your trip to Florida. Thank you for the comment. I appreciate your visit.

Bill De Giulio

4 years agofrom Massachusetts

Hi Linda. Very interesting. I had never heard of the Chikungunya Disease before. We just returned from Florida and was not aware that the Mosquitoes there could be carrying this disease. Great info for future reference. Once again I learned something new today.

AUTHOR

Linda Crampton

4 years agofrom British Columbia, Canada

Happy Hump Day to you too, Thelma! Thank you very much for the comment.

Thelma Alberts

4 years agofrom Germany and Philippines

Thank you very much for writing this very useful and informative hub. I have learned a lot. Happy Hump Day!

AUTHOR

Linda Crampton

4 years agofrom British Columbia, Canada

Thanks for reading the hub, tirelesstraveler. I hope it doesn't happen, but we may be hearing a lot more about chikungunya in the near future!

Judy Specht

4 years agofrom California

Chikungunya is certainly a new disease to me. Thanks for the information.

Reading through the symptoms and knowing someone with RA, I sure hope not to get either one of these. The world is certainly smaller than ever before, and our diseases sure don't respect borders.

AUTHOR

Linda Crampton

4 years agofrom British Columbia, Canada

Thanks, StephSev108. I appreciate your visit.

Stephanie Marie Severson

4 years agofrom Atlanta, GA

Thank you for an interesting and much needed hub.

AUTHOR

Linda Crampton

4 years agofrom British Columbia, Canada

Thank you very much, Jo.

Jo Alexis-Hagues

4 years agofrom Lincolnshire, U.K

Interesting and useful information and as always, beautifully presented.

AUTHOR

Linda Crampton

4 years agofrom British Columbia, Canada

Thank you very much for the vote and all the shares, Peggy. The mosquito eradication program in your area sounds very useful. It's definitely scary that the mosquitoes are moving into new areas!

Peggy Woods

4 years agofrom Houston, Texas

Hi Alicia,

Very informative and detailed hub! We have plenty of mosquitoes here in Houston. I am glad that our subdivision dues pays for once a week mosquito eradication spraying during many months of the year but that does not mean other precautions need not also be addressed. Rather scary that the diseases are moving further north because of the warming temperatures. Up votes, pinning, tweeting, G+ and sharing.

AUTHOR

Linda Crampton

4 years agofrom British Columbia, Canada

Hi, ologsinquito. The virus has been in the news a lot recently. It does cause a horrible infection. It's good that fatalities are rare, although it's sad that anyone has to die from the disease.

ologsinquito

4 years agofrom USA

I just heard about this terrible virus a few months ago. It sounds dreadful.

AUTHOR

Linda Crampton

4 years agofrom British Columbia, Canada

Best wishes, breakfastpop. I hope you continue to avoid the mosquitoes! I would definitely take the precautions that you do if I was in an area where mosquito-borne disease was common.

AUTHOR

Linda Crampton

4 years agofrom British Columbia, Canada

Thank you very much for sharing your experience, VioletteRose. I'm so glad that you recovered fully and didn't have any problems after the chikungunya infection! Your story is very scary.

AUTHOR

Linda Crampton

4 years agofrom British Columbia, Canada

Thank you very much, Bill!

breakfastpop

4 years ago

I travel to the Caribbean quite a bit, and I now live in fear of this new form of danger from a bite. I have always worn boots, pants and long sleeves when walking about, and I have been doing so for 25 years! Dengue fever is also a threat and I don't want to take any chances, because mosquitoes love me!

VioletteRose

4 years agofrom Chicago

Great hub. I had Chikungunya 8 years back. I was very healthy until one day afternoon, then I had difficulty with walking due to the problems in joints. In fact I was watching a film in the theatre, and I just realized the problem after the film was over!

We went to the hospital and I was admitted there for three days, but just taking fluids, pain killers and taking rest. You are right that there is no medicine. The best medicine is getting enough rest, and it will naturally cure by itself. I was back to being healthy in about a month. In my case I didn't have any long term health problems from Chikungunya. However, those who didn't get enough rest had problems later in life. Age is also a factor it seems.

Bill Holland

4 years agofrom Olympia, WA

And my education continues and I thank you for it!

AUTHOR

Linda Crampton

4 years agofrom British Columbia, Canada

Hi, Devika. Thank you very much for the comment and the votes! I appreciate your visit, as always.

AUTHOR

Linda Crampton

4 years agofrom British Columbia, Canada

Hi, Patricia. I would love to visit Florida to see its wildlife, but I would prefer to avoid the mosquitoes! I'm sorry to hear the sad story about your aunt. It's good to hear that she didn't let RA interfere with her life, despite the pain. Thanks for the angels!

AUTHOR

Linda Crampton

4 years agofrom British Columbia, Canada

I'm very sorry about the pain in your toes, Faith. I hope you find relief soon. At the moment we are more likely to get chikungunya if we travel to another country, but this may not be the situation for long. As always, I appreciate your kind votes and shares!

Devika Primić

4 years agofrom Dubrovnik, Croatia

A well-shared hub! A great discovery and so interestingly researched.Voted up, interesting, and useful.

Patricia Scott

4 years agofrom sunny Florida

I live in Florida so this was of great interest to me. We are ever vigilant here as there are other worrisome illnesses caused by mosquitoes here too as you must know.

My one precious Aunt had RA and she was in pain most of her 95 years. It was heartbreaking but she never let it stop her from and active and full life.

Angels are on the way to you today ps

Faith Reaper

4 years agofrom southern USA

Interesting insight you have provided here as to the difference between the two. I have not heard of Chikungunya. We have plenty of mosquitoes here in the deep south, but not tropical. Hopefully, we are not susceptible to Chikunguna unless we travel to another country?

I have been having terrible (well, I call them cramps) pain in my toes where the bones become distorted looking, so I hope that is not a sign of arthritis! It is very painful.

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